Approach to the patient with pulmonary disease

The approach to the HIV-infected patient with pulmonary disease is summarized by the algorithms in Figures 3 and 4. These are not intended to be followed in a rigid step-wise fashion. Rather, the practitioner's knowledge of the patient with his or her accompanying medical risks influences the path taken, including the depth and the speed of the evaluation. For example, the patient with cough who is afebrile and breathing at 18 breaths a minute, with a normal chest radiograph and a CD4 count of 350 cells/mm3, is reasonably treated with a macrolide or cephalosporin for bacterial bronchitis and clinical follow-up while awaiting cultures (see Fig. 4). A febrile patient with a cough productive of thin mucus, but known to have a CD4 count of 60 cells/mm3 should be started on anti-PCP therapy while being evaluated for PCP with an induced sputum and if nondiagnostic, a bronchoscope despite a normal chest radiograph. Screening can be as simple as placing an oximeter on the patient's finger in the clinic. If the oxygen saturation of a patient with a normal chest radiograph is low, then the patient should be hospitalized and begun on treatment for PCP while diagnostic evaluation is initiated. If the oxygen saturation is normal, the patient can be exercised to elicit desaturation. If there is no desaturation, PCP is unlikely. If the results are equivocal (i.e., a decrease in saturation, but less than 3%), rest and exercise arterial blood gases can be performed, along with a Dlco-Gallium scanning can be done in patients known to have abnormal Dlco or those who cannot exercise. Patients with focal infiltrates who have acute onset of symptoms (see Fig. 4) commonly have bacterial infections, but the possibility of PCP or TB should not be dismissed. Induced sputum should be examined if TB or PCP is suspected. Patients who are severely ill might go quickly to bronchoscopy without awaiting improvement on empiric therapy. The patient with diffuse infiltrates (see Fig. 4) needs no screening because the presence of disease is apparent from the radiograph. The diagnostic part quickly leads to bronchoscopy for these patients and the initiation of therapy for PCP when suspected. In patients with known pulmonary KS, gallium scanning can be helpful to rule out acute infection, but bronchoscopy is warranted if the patient is severely ill, or at high risk for PCP. This approach should avoid unnecessary procedures in patients with simple bacterial infections, without missing opportunistic infections and tumors.     

Manipulation of matter by electric and magnetic fields: Toward novel synthesis and processing routes of inorganic materials

The use of external electric and magnetic fields for the synthesis and processing of inorganic materials such as metals and ceramics has seen renewed interest in recent years. Electromagnetic energy can be utilized in different ways to improve or accelerate phase formation and stabilization, chemical ordering, densification and coarsening of particle-based materials (pore elimination and grain growth), and mechanical deformation (plasticity and creep). In these new synthesis and processing routes, the resulting microstructures and macroscopic material behavior are determined by the interaction of the applied fields with defects such as single or clustered point defects, dislocation networks, and interfaces. Multiscale experimental investigations and modeling are necessary to unveil the mechanisms underlying this field-assisted manipulation of matter.     

Developing Web literacy in collaborative inquiry activities

Although many children are technically skilled in using the Web, their competences to use it in a critical and meaningful way are usually less well developed. In this article, we report on a multiple case study focusing on the possibilities and limitations of collaborative inquiry activities as an appropriate context to acquire Web literacy skills in primary education. Four 5th grade school teachers and their students worked with collaborative inquiry activities on the subject of ‘healthy food’. The project was aimed at both the development of Web literacy skills and content knowledge building. Data from a variety of sources were collected: videotaped and written lesson observations, interviews with teachers and students, teacher diaries, student questionnaires, and student assignments. The teachers appeared to be able to carry out the program to varying degrees. Contextual factors that influenced the realization of the project’s goals and results were the adequacy of the research questions formulated by students, students’ inquiry skills, and the teachers’ teaching styles. Students’ learning results show that it is possible to teach Web literacy skills in the context of collaborative inquiry activities. All classes show knowledge gain with regard to the subject healthy food and all classes but one show knowledge gain with regard to Web literacy skills. Although many students show adequate use of particular Web searching, reading and evaluating skills after the project, inconsistency, impulsiveness and impatience are also typical of their Web behaviour. In the context of collaborative inquiry activities teachers are challenged to deal with the paradox that they want their students to be active knowledge builders with help of the Web, whereas the Web seems to invite students to be more or less passive searchers.     

Efficient randomised broadcasting in random regular networks with applications in peer-to-peer systems

We consider broadcasting in random d-regular graphs by using a simple modification of the random phone call model introduced by Karp et al. (Proceedings of the FOCS ’00, 2000). In the phone call model, in every time step, each node calls a randomly chosen neighbour to establish a communication channel to this node. The communication channels can then be used bi-directionally to transmit messages. We show that, if we allow every node to choose four distinct neighbours instead of one, then the average number of message transmissions per node required to broadcast a message efficiently decreases exponentially. Formally, we present an algorithm that has time complexity \(O(\log n)\) and uses \(O(n\log \log n)\) transmissions per message. In contrast, we show for the standard model that every distributed algorithm in a restricted address-oblivious model that broadcasts a message in time \(O(\log n)\) requires \(\Omega (n \log n{/} \log d)\) message transmissions. Our algorithm efficiently handles limited communication failures, only requires rough estimates of the number of nodes, and is robust against limited changes in the size of the network. Our results have applications in peer-to-peer networks and replicated databases.     

Flood Risk Management in Flanders: Past Developments and Future Challenges

This paper presents the state of the art of flood risk management in Flanders, a low-lying region in the northern part of Belgium which is vulnerable to flooding. Possible flood hazard sources are not only the many rivers which pass through the Flemish inland, but also the North Sea, which is sensitive to the predicted sea level rise and which can affect large parts of the Flemish coastal area. Due to the expected increase in flood risks in the 21st century, the Flemish government has changed its flood management strategy from a flood control approach to a risk-based approach. Instead of focusing on protection against a certain water level, the objective now is to assure protection against the consequences of a flood, while considering its probability. In the first part, attention is given to the reasoning and functioning of the risk-based approach. Recent improvements to the approach are discussed, as well as the GIS-implementation of the entire model. The functioning of the approach is subsequently demonstrated in two case studies. The second part of the paper discusses future challenges for the flood risk management in Flanders. The driving force behind these challenges is the European Directive on the assessment and management of flood risks, which entered into force in 2007. The Flemish implementation of the directive is discussed and situated in the European landscape. Finally, attention is given to the communication of flood risks to the general public, since the “availability” of flood risk management plans is among the requirements of the EU Floods Directive.     

A Multiphase Pore Scale Network Model of Gas Exchange in Apple Fruit

A multiphase pore scale network model was developed to describe mass transfer in apple fruit. The 3D microscale geometry of the tissue was reconstructed from synchrotron radiation tomography images. Individual cells and pores were identified using a watershed segmentation procedure on a Euclidean distance map of the tissue microstructure. Further morphological characteristics of each individual pore, including its volume, connections to the neighbors and the connected area between the pore and its neighbors, were determined. The tissue was represented by a network of nodes (simplified individual pores and cells) that were interconnected by tubes. The transport of the respiratory gases O₂ and CO₂ between two nodes was modelled using diffusion laws and irreversible thermodynamics, while respiration was taken into account in the individual cellular nodes. A numerical procedure was applied to simulate the gas transport within the discrete network and to compute the local diffusivities of the links in the network. The predicted overall gas diffusivities compared well to experimental data and results computed from a microscale continuum model, thereby validating the pore scale network model. This approach is a computationally attractive alternative to a continuum multiphase approach for modelling gas transport in fruit.     

3D Virtual Pome Fruit Tissue Generation Based on Cell Growth Modeling

A 3D virtual fruit tissue generator is presented that can distinctly define the microstructural components of a fruit tissue and that can be used to model important physical processes such as gas transport during controlled atmosphere storage. The model is based on the biomechanics of plant cells in tissues. The main merit of this algorithm is that it can account for typical differences in intercellular air space networks and in cell size and shape found between different fruit species and tissues. The cell is considered as a closed thin walled structure, maintained in tension by turgor pressure. The cell walls of adjacent cells are modeled as parallel, linear elastic elements which obey Hooke's law. A 3D Voronoi tessellation is used to generate the initial topology of the cells. Intercellular air spaces of schizogenous origin are generated by separating the Voronoi cells along the edges where three Voronoi cells are in contact; while intercellular air spaces of lysigenous origin are generated by deleting (killing) some of the Voronoi cells randomly. Cell expansion then results from turgor pressure acting on the yielding cell wall material. To find the sequence of positions of each vertex and thus the shape of the tissue with time, a system of differential equations for the positions and velocities of each vertex is established and solved using a Matlab ordinary differential equation solver. Statistical comparison with synchrotron tomography images of fruit tissue is excellent. The virtual tissues can be used to study tissue mechanics and exchange processes of important metabolites.